Conflict on Dual Medic Units

[medic001918]

I don't start an IV on all my patients that I transport either, but what do you say to those nurses who whine "What? No IV??" when you're wheeling your patient into the ER who doesn't have an IV in place?

That's simple. There was no need to start an IV on the patient. End of discussion.

Embarassingly, in the past, I've started an IV on some patients who I felt DIDN'T need one, just so that I didn't have to put up with the wrath of some of the nurses in the ER when I get there.

Sometimes it's just easier that way....anybody catch my drift??

No, I don't get your drift. When should we put our relationship with the receiving facility in front of patient care? If the patient doesn't need it, they don't need it. There's nothing else really to say about it.

If it needs to be done, I do it, if I can justify why it didn't need to be done, then I do that on behalf of my patient as well.

Except to shut up the nurses.....

So again, why are you putting nurse's attitude's in front of patient care?

I just can't agree with doing something to keep a nurse happy when a patient doesn't need an intervention pre-hospital. Maybe I just don't understand it. The one person I worry about when deciding on an intervention is the patient.

Shane

NREMT-P

[Connie31079]

Quote: "...why are you putting nurse's attitude's in front of patient care?"

Answer: Because I don't like the nursing staff making me feel like I'm a retard, that's why.

Shane, obviously you've never had a problem with a nurse questioning your treatment when you've wheeled your patient into the ER without a line in place. Good for you.

I've had problems with them in the past, maybe you should count your blessings that you've never had that problem.

I've actually been reported by nursing staff in the past because I didn't start on a line on a patient who THEY felt needed an IV. I felt differently and told them so, but they didn't concur, and decided to call my supervisor on it.

Literally, whining on the phone, asking why not EVERY patient transported by ambulance doesn't have IV access in place, because "they're just going to get an IV when they get here" (meaning the ER, I guess).

Needless to say, nothing ever came of it, but it still irritates me to this day that I even had to explain my actions.

Obviously, some nurses feel that we lack the knowledge of when a patient should and should not receive IV access.

[Scaramedic]

Let them report you, let them bitch who cares. If your system doesn't tell them to pound it then as I have said before to others, your system sucks!!!

Let me give some answers next time you run in to this.

RN: Why doesn't this patient have an IV?

You: I didn't feel that a hangnail needed an IV your highness.

RN: Yes but we might have to draw blood.

You: I suggest you call the lab and ask a Med Tech if they want you to draw from a line or a saline lock. They will tell you NO, it skews the results. Any good phlebotomists knows you do not draw out of lines or locks unless it is absolutely necessary.

RN: But your protocols state that you must start an IV.

You: No, my protocols state an IV SHOULD be obtained on any patients who might need pharmaceutical intervention or fluid resuscitation. It does not state an IV MUST be obtained on every patient I bring to your damn ED. Since you are quoting my protocols let's discuss the portion that says that Medical Control is considered the MD you are dealing with on MRH (Medial resource Hospital, or receiving facility) not the RN on MRH.

RN: I am going to call your supervisor.

You: Please feel free the number is XXX-XXXX and please leave your name so we know who to laugh at later. Have a nice day.

YOU are the patient advocate for the patient in YOUR care. It is not ethical to base your decisions on whether or not you are going to piss off a nurse at the ED.

Peace,

Marty

[Paradude]

Connie, If you don't feel a patient needs an IV, then don't start one. An ER nurse doesn't make that decision for you. If you are asked why you didn't, and you have a valid answer, then tell them that answer, and have some confidence in your treatment decisions. If you don't have a valid answer, then maybe you should have started an IV.

I start alot of IV's , put on alot of cardiac monitors, and check alot of blood glucose levels. I do that, when I cannot come up with a valid reason not to. Part of not being a cook book medic, is being able to give your reasoning behind your decisions. Cook Book medics (in my opinion) are ones who do treatment based on black and white findings. (ie. if you see sign or symptom 'a' then you administer treatment 'a' and so on) Being a good pre-hospital care provider means that you must THINK. You have to have a good working knowledge of A & P, and what your treatment modalities actually mean, and devise your strategy from there.

I have been asked about my treatments from nurses and doctors, and I just give them the straight answer, period and point blank. I have enough confidence in myself to feel good about what I do. If I have made a mistake, then I say so, and learn from it. If they disagree, then that is there right, but they were not in the field with my patient. I was.

-Paradude-

[medic001918]

Quote: "...why are you putting nurse's attitude's in front of patient care?"

Answer: Because I don't like the nursing staff making me feel like I'm a retard, that's why.

Shane, obviously you've never had a problem with a nurse questioning your treatment when you've wheeled your patient into the ER without a line in place. Good for you.

I've had problems with them in the past, maybe you should count your blessings that you've never had that problem.

I've actually been reported by nursing staff in the past because I didn't start on a line on a patient who THEY felt needed an IV. I felt differently and told them so, but they didn't concur, and decided to call my supervisor on it.

Literally, whining on the phone, asking why not EVERY patient transported by ambulance doesn't have IV access in place, because "they're just going to get an IV when they get here" (meaning the ER, I guess).

Needless to say, nothing ever came of it, but it still irritates me to this day that I even had to explain my actions.

Obviously, some nurses feel that we lack the knowledge of when a patient should and should not receive IV access.

I have had treatment's questioned by nurse's and physicians. And I've been able to provide my rationale for my decision to do something, or not do something in those cases. Personally if I know a patient doesn't need an IV, I'm not going to feel like a "retard" for not starting one. I have an obligation to advocate for my patient and to provide appropriate treatment. If an IV isn't needed prehospital, it's not needed. A nurse's attitude won't change that. If they want to complain, let them. Your company needs to talk to their personnel and explain the way things are. Are you doing any service to anyone but yourself by starting an IV on a patient that doesn't need it? Most hospital's aren't going to draw blood from your line or lock, so the patient gets stuck again. Sounds like a good deal for the patient. They get an extra needle stick simply so you don't have to deal with a nurse who doesn't know EMS protocol and clinical decision making? If this is a chronic problem with a particular ED, maybe someone needs to talk to the EMS director and see if they know about it? More importantly, can they do anything to correct it?

I'm still not seeing your point to starting an IV on a patient when it's not clincally indicated, only to avoid a confrontation with a nurse. If the patient doesn't need one, and you can validate why they don't need one...then don't start one. By starting an IV that's not needed, you're only serving yourself.

Shane

NREMT-P

[CBEMT]

Answer: Because I don't like the nursing staff making me feel like I'm a retard, that's why.

Shane, obviously you've never had a problem with a nurse questioning your treatment when you've wheeled your patient into the ER without a line in place. Good for you.

Get thicker skin. If every ED nurse with an attitude ruins your entire day and changes your patient care, I'm not sure EMS is for you.

[Connie31079]

Geez, I wish you would have told me that 16 years ago, CBEMT! Then I wouldn't have become involved in EMS, and I would have done something completely different because you don't feel EMS is for me! LOL!

Geeez, what do I do now??? *L*

[Dustdevil]

Okay, folks, this entire fourth page has nothing to do with conflict between medics.

In fact, it has nothing to do with conflict on ambulances at all.

Focus, please, or go start your own "conflict between medics and ER nurses" thread.

[brentoli]

Okay, folks, this entire fourth page has nothing to do with conflict between medics.

[Connie31079]

Sorry Dust. I answered your orginial question at the bottom of my original response, but when I try and explain why I do what I do, somebody always jumps down my throat.

And people wonder why I don't post that much in the forums anymore. I think they've proved my point.

Maybe I should go back into hiding.